LONGMONT -- Whether you call it the Patient Protection and Affordable Care Act, the Affordable Care Act for short or simply Obamacare, you should know that for many people, Oct.1 was a critical day in the implementation of the new law.

The beginning of the month was when the open enrollment period began for those who do not have insurance. Another important date is Jan. 1 -- that's when everyone, with few exceptions, is required to be covered by an insurance plan that is approved under the new law, according to Kurt Mann of First MainStreet Insurance.

Individuals who don't have insurance must enroll in a plan by Dec. 15 for their coverage to kick in Jan. 1.

Individuals and companies that don't comply with the law will face a penalty after Jan. 1.

Mann said he is urging people to take their time and shop carefully.

"I'm not saying wait until (Dec. 15) -- that's probably not the best time because of the procrastinators of the world -- but I'm saying you've got time," said Mann, one of the four owners of First MainStreet Insurance and its benefits manager. "The month of November is probably a good time to get after it."

A smooth start to Colorado's exchange

Those who don't have insurance and want to avoid paying a penalty have two options for buying insurance: shop around on the open market or go through their state's or the federal government's marketplaces -- or exchanges, as they're also called.

Colorado is one of 14 states that have set up exchanges to help people and small companies find insurance plans and apply for subsidies to buy insurance if they need them.

Colorado's exchange is called Connect for Health Colorado, a nonprofit set up by the Colorado Legislature.

"Our state's exchange is different than most states because we're not a part of state government; we're a stand-alone nonprofit," said Ben Davis, a Connect for Health spokesman.

Davis is issuing week-by-week reports of Connect for Health's activities. During week one, Connect for Health had 162,941 unique visitors to its website; 9,658 calls to its customer service representatives; 18,174 accounts created; and 226 enrollments in plans that covered 305 people.

"It has been very successful so far," said Davis. "We don't really view enrollment as a sign of whether we're going to be successful at this point."

Instead, he said, he and his board of directors look at the number of unique visits to the website and the number of accounts created.

The average time someone spent on hold waiting to talk to a customer service rep was 5:44, and 33 percent of the calls were answered within 20 seconds.

Ryan Volk, of VolkBell, an employee benefits company, speaks at a recent meeting of the Longmont Area Human Resources Roundtable at The Fox Hill Club in Longmont.
(Lewis Geyer/Times-Call)

He said Connect for Health's customer service reps are prepared to answer any type of question they're asked, and Davis said it's important to note that individuals and businesses can go online and shop anonymously, without creating an account.

First MainStreet's Mann said he thinks Connect for Colorado is doing "a pretty amazing job," considering the size of its task.

"They're good people, they're trying hard, and I think it's working better than the federal one," Mann said. "You can go from having your Google page up to having a rate in no time."

People living in states that did not set up an exchange have to go to the federal government's exchange at healthcare.gov. Ryan Volk of VolkBell, an insurance brokerage, told the Longmont Area Human Resources Roundtable recently that that's where some of the horror stories of a rough roll-out have been coming from.

"The biggest problems have been in states that want the feds to run it," said Volk.

He told the roundtable that it wasn't mandatory that uninsured people go through the exchange.

"Whether you go through an exchange or buy direct, the plans are (basically) the same and the rates are the same," said Volk, adding that the exchange will actually have fewer plans for people to choose from. "The main reason you'd go there is to qualify for the subsidy. Otherwise, the market is what it is."

Why brokers are important

Mann said he and other brokers like him have gone through hundreds of hours of Connect for Health training to learn how to navigate what is a complicated system.

"It's a lot more difficult to pick a plan than people think," Mann said.

At Connect for Health, individuals and families can choose from up to 150 private health insurance plans from 10 carriers. Small employers -- those with fewer than 50 full-time-equivalent employees -- can create small group plans from up to 92 health insurance plans provided by six carriers.

While it may sound self-serving that he should tell people they should go through a broker, there are a couple of reasons why, Mann said. First, the insurance companies -- not the insurance buyers -- pay the brokers. And because the carriers all pay the same commission to brokers, they are under no pressure to steer a person to one plan or another.

"Bottom line, we just want you enrolled because that's how we get paid," Mann said.

Secondly, the plans are complicated. A customer living in Longmont might inadvertently sign up for a plan that would exclude him or her from using Longmont Clinic or Longmont United Hospital, for example. That's where the brokers' many hours of training come in, he said.

Connect for Health has a "find a broker" section on its website. To be listed, a broker must have completed Connect for Health's training.

Suzanne Bragg-Gamble, executive director of CoverColorado, concurs that those shopping for insurance should find a broker.

CoverColorado, the state's high-risk insurance pool which has been providing insurance to people who otherwise couldn't get it for more than 20 years, will be going out of business as a result of the new law.

The nonprofit serves 13,700 members statewide and almost 1,500 in Boulder County. It also has 1,168 members in Larimer County, 562 in Weld County and 154 in Broomfield County.

All of these people will be transitioning into new ACA-approved plans, and Bragg-Gamble and her staff are recommending they start by contacting a certified broker.

"We're urging all our members to get enrolled by Jan. 1," she said.

That her agency will no longer be needed is one of the positive things about the Affordable Care Act, she said.

However, the pre-existing conditions clause is causing headaches for carriers, said Kaye Pyle of VolkBell.

The problem for them, she said, is "they don't know how to rate for it."

"All of the carriers are flying blind right now," Pyle said during her and Volk's presentation to the HR Roundtable.

As a result, ACA-approved plans come with what's called a "Transition Reassurance Fee." The fee, $63 per person covered by an individual policy, will go into a fund that will reimburse carriers that end up with a disproportionately large number of high-risk customers in their client pool. Such carriers will only have a short time to figure out how to bring more low-risk people into their client pool, because that fee will sunset after 2016, after which the carriers are on their own, Pyle said.

Mann said the pre-existing condition clause is one of the major cornerstones of the new health care law.

"Guaranteed issue is a big deal," he said. "Insurance is based on 'Let me examine your risk and I'll give you a price.' We've taken that off the table."

Tony Kindelspire can be reached at 303-684-5291 or tkindelspire@times-call.com.

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